Provider Demographics
NPI:1588617344
Name:RICHTER, CALEB J (PA)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:J
Last Name:RICHTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18086 GOODNOUGH ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13606-2257
Mailing Address - Country:US
Mailing Address - Phone:315-778-3955
Mailing Address - Fax:
Practice Address - Street 1:214 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1212
Practice Address - Country:US
Practice Address - Phone:315-493-0128
Practice Address - Fax:315-493-6200
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1172Medicare ID - Type Unspecified
NYQ58074Medicare UPIN